ACA complaints at one year

[modhatter]

And we wonder why our insurance costs here in America are out of control.

 

[travelover]

The problem you run into in one I ran into a few years ago (so this is all pre-ACA). I was having surgery and I wanted to make sure everyone was in network. The doctor and hospital were. But, the hospital said that none of the anesthesiologists were in network nor would the assistant surgeon be in network. (The assistant surgeon was required by the hospitla). This was because the anesthesiologists and assistant surgeons were not in any network. So I looked into going to another hospital. However, the same group of anesthesiologists and assistant surgeons provided those services to all the hospitals in the area.

What really irritated me was when the assistant surgeon billed something like 10x what insurance paid the actual surgeon. The policy we had did provide that the insurer would treat the anesthesiologist and radiologist and a couple of other provides as in network and reimburse at that rate rather than the out of network rate. I also got the insurer to agree to pay the assistant surgeon at the in network rate.

Of course, the issue that could have come up was that the insurer paid them the same discounted rate they would have paid an in network doctor. I was worried that these out of network providers would try to come after me for the difference, but they didn't.

Still it was so annoying since there was literally no one that was in network for those services.

I think that this sums it up nicely. We basically have an ongoing situation whereby even sophisticated consumers are being held hostage by certain greedy medical providers and Congress absolutely refuses to intervene.

 

[ArkTinkerer]

I think that this sums it up nicely. We basically have an ongoing situation whereby even sophisticated consumers are being held hostage by certain greedy medical providers and Congress absolutely refuses to intervene.

But flip the situation the other way-- should the medical staff be forced to work at a wage the government or an insurance company sets if they want to practice medicine?

I think the mess is because we have become disconnected from the costs of care. Getting this straightened out is going to be painful whichever way we go. And the problem goes very deep--Costs to educate doctors are as inflated as any degree if not more so. Residents are overworked and under paid and they need to be compensated for all those years as well. Countries without socialized medicine have found ways to do it cheaper and even turn a profit but its not just a healthcare problem. Tort reform, health insurance that is not really insurance, education costs, billing issues, etc all play into it.

 

[travelover]

But flip the situation the other way-- should the medical staff be forced to work at a wage the government or an insurance company sets if they want to practice medicine?

I think the mess is because we have become disconnected from the costs of care. Getting this straightened out is going to be painful whichever way we go. And the problem goes very deep--Costs to educate doctors are as inflated as any degree if not more so. Residents are overworked and under paid and they need to be compensated for all those years as well. Countries without socialized medicine have found ways to do it cheaper and even turn a profit but its not just a healthcare problem. Tort reform, health insurance that is not really insurance, education costs, billing issues, etc all play into it.

I see your point, but when the assisting surgeon wants to get paid 10X what the primary surgeon is paid, that rate is not agreed upon ahead of time and the patient may have no alternative anyway, we have a major problem.

A major issue is that the charging system is deliberately opaque, especially to the patient, who used to not care. Now that the patient has more skin in the game with co-pays and deductibles, the medical industry wants to continue on with this hide the real charges game. That is where we need legislation to protect the patient.

 

[ArkTinkerer]

I see your point, but when the assisting surgeon wants to get paid 10X what the primary surgeon is paid, that rate is not agreed upon ahead of time and the patient may have no alternative anyway, we have a major problem.

A major issue is that the charging system is deliberately opaque, especially to the patient, who used to not care. Now that the patient has more skin in the game with co-pays and deductibles, the medical industry wants to continue on with this hide the real charges game. That is where we need legislation to protect the patient.

I'm sure the primary surgeon would like to be paid 10X as well! But I do agree. To me the two primary points are 1) "have no alternative" and 2) "charging system is deliberately opaque". The first issue is due almost entirely to the government limiting the number of residency slots and regulating the number of hospitals. Of course its exacerbated by the desire for profits from our for-profit and non-profit (yep, people make lots of money with non-profits!) hospitals. But then, how can you compete if you have to pay your resident physicians and other hospitals get theirs courtesy of the feds? The opaque is probably somewhat due to a history of customers not caring but I grant that a lot of it may be providers not wanting to show their cards. Trying to compare "list" cost with what providers really pay is near impossible. Some of that is changing. Our insurance at w*rk allows us to see the costs of procedures at all surrounding facilities. DW has gotten very good at calling and checking on prescription prices. More work for us but it has saved substantial $$$ over the last few years.

 

[Walt34]

Thank you all for a thoughtful discussion.